Videoendoscopic Diagnosis and Correction of Velopharyngeal Stress Incompetence in a Bassoonist

Musicians who play woodwind or brass instruments must generate extremely high intraoral pressures to achieve normal tone and volume in their music. Intraoral pressures of 130 mm Hg can be reached, while normal speech rarely exceeds 6 mm Hg. The inability to maintain an effective seal between the soft palate and the pharyngeal wall can manifest as difficulty in holding high notes or in playing sustained music compositions, or noise production from turbulent nasal cavity emissions. Throughout the literature, there are few reports of these entities. We will present the case of a 31-year-old concert bassoonist who complained of "noise from her head" only when she played the bassoon. This resulted in numerous failed auditions and threatened her professional career. The diagnosis of velopharyngeal stress incompetence, as well as the Teflon injection augmentation procedure, was done under local anesthesia with the subject playing the bassoon. The use of videoendoscopic techniques allowed accurate, reproducible assessment of the defect and the operative procedure, and assisted in postoperative evaluation.